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DOI: 10.1055/s-2002-35134
© Georg Thieme Verlag Stuttgart · New York
Knochendefekte beim Knieendoprothesenwechsel: Klassifikation und Management
Bone Defects in Revision Total Knee Arthroplasty: Classification and ManagementPublication History
Publication Date:
29 October 2002 (online)
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Zusammenfassung
Die Rekonstruktion der knöchernen Defekte beim Knieendoprothesenwechsel hat zwei Zielstellungen: den Wiederaufbau eines stabilen Implantatlagers sowie die Wiederherstellung der korrekten Lage der Gelenklinie. Hierfür ist eine sinnvolle, therapiebezogene Klassifikation der vorliegenden Defekte unverzichtbar. Nach Stockley et al. (1992) erfolgt die Einteilung in zentrale und periphere Defekte. Periphere Defekte sind mit strukturierten Knochenblöcken oder metallischen Wedges zu substituieren, zentrale Defekte können mit allogener Spongiosa aufgefüllt werden. Bei aseptisch gelockerten Oberflächenendoprothesen ist die Defektklassifizierung von Engh und Parks (1994) hilfreich, da diese eine direkte Anleitung für das therapeutische Vorgehen beinhaltet. Bei den häufiger vorliegenden erst- und zweitgradigen Defekten erfolgt die Defektrekonstruktion durch modulare Revisionskomponenten oder allogene Knochentransplantate, für die seltenen drittgradigen Defekte werden massive Allografts oder modulare Tumorendoprothesen empfohlen. Anhand von mehr als 150 Wechseloperationen im eigenen Krankengut werden in dieser Übersichtsarbeit die Klassifikationen und ihre therapeutischen Konsequenzen dargestellt.
Abstract
The goal of bone reconstruction in revision total knee arthroplasty is to provide a stable support for the implant and to re-establish the correct joint line. Therefore, a useful, therapy-based classification of the defects is necessary. According to Stockley et al. (1992), the defects are classified into contained and uncontained defects. Uncontained defects can be reconstructed using structural allografts or metal wedges. In contained defects, cancellous allograft can be used. For aseptic loosening of total knee arthroplasty, the defect classification according to Engh and Parks (1994) can be helpful because of its recommendations for reconstruction. In case of the more common first or second graded defects, reconstruction is performed using modular revision components or allografts. For the rare third graded defects, bulk allografts or modular tumour endoprostheses are recommended. On the basis of more than 150 revision total knee arthroplasties performed in our hospital the classification of bone defects and their clinical consequences are presented in this review.
Schlüsselwörter
Knieendoprothesenwechsel - Knochendefekt - Klassifikation - Rekonstruktion
Key words
Revision total knee arthroplasty - bone defect - classification - reconstruction
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PD Dr. med. H. Reichel
Universitätsklinik und Poliklinik für Orthopädie
Martin-Luther-Universität Halle-Wittenberg
Magdeburger Str. 22
06097 Halle (Saale)
Phone: 03 45/5 57 48 03
Fax: 03 45/5 57 13 02
Email: heiko.reichel@medizin.uni-halle.de